MD::MPH::Artist::Activist intrigued by stories of the medical experience, healthcare politics, meded, global health and art. Excited by social media's power to teach, engage and change. I ruminate on these topics in this blog.

Sunday, December 13, 2009

Today surgery began. The transition is bitter more than sweet. I remember dreaming of being a neurosurgeon when I was a child, writing about it in my personal statement for college. But now, it seems so far away. Medicine is a place where you find yourself. You spend a significant amount of time interacting with varying personalities, adjusting to new teams of people, new environments. You can never get too settled or too comfortable and so you're always forced to question, who you are, what you're about and to prove your worth, if not to anyone else, to yourself. And I find myself today, wishing I was still in internal medicine, wishing I had done more, taken more from the experience and dreading the famed personalities of the surgical house staff. Of course, waking up early is also not something I'm excited about, but that aside, I fear my laid back nature will be ruffled in the coming 12 weeks and I pray my soul can bear the struggle. I find myself, out of character and instead of being my usual optimistic self, I dread the coming weeks. I pray for blessings, peace and guidance in all my forthcoming doings.

12 weeks have gone by and I should have been writing an article a day but that didn’t happen. What’s new? Time flies when you're having fun, they say, or time flies when you're tired, disorganized and scared. I'm pretty preoccupied with the future -- with deciding how what specialty fits into my life plan (or fits my emotional and egotistical desires that day) and when I should take step 2, step 3, which residencies to apply to, worrying about my visa status. Instead of just studying now. I have to admit, I enjoy planning my not so distant future and obsessing over it, but I also need to save some of that energy up for the situation that's right before me - rotations. It's week 11 of 12 for IM, my first rotation as an MSIII and fortunately, I'm not burnt out yet. I'm tired, but not burnt out (I think). I still enjoy meeting patients, hearing their stories, figuring out their problems and navigating the galaxy of differentials, diagnostics and treatments. But I'm really good at finding the joy in things and that sometimes can be a curse. It makes decision-making difficult because I'm unable to find subjective reasons that would help me rule out or rule in certain factors. I can only hope, that in the next year, I can be truly honest with myself, truly understand myself to know what I would be most fulfilled with in the future.

This week my patient died. She was 76 years old. Chinese lady. Brought in because of a UTI and found to be in respiratory distress. I met her, tubes down her throat, respirator injecting air into her lungs every 3 seconds, unconscious. Unaware of her present state - her inability to breathe on her own, her incontinence and the massive swelling all over her tiny body. She was oozing fluid as she was most likely protein deficient and had developed edema as a result. The fact that she was on normal saline did nothing to ease this either. She died at night. I wasn't there, but I can't help but wonder the cause of her death. Could it have been pulmonary edema? She was edematous in all other places, why not the lungs too? Coming to work the next day and hearing that she had expired left me somewhat dejected for the rest of the day. Of the four days she had been in the hospital, no family members had ever come to visit. She died alone, cold, swollen on a hospital bed. Who knew the fulfilling life she once lived?! I said a prayer. That in passing on, she be blessed.

In contrast, the next day, another patient passed. This Chinese lady was surrounded by family even before her passing. They took shifts so she was always in the company of a dear family member throughout the day. When we rounded, her granddaughter was there. She could not be more than 22 years old. She flew in from Europe to be at her ailing grandmother's bedside. The day she died, There were at least 15 people in that room, solemn and red-eyed. They had expected it and had made peace with what transpired. Even in this sad moment they chose to thank us, the medical staff, profusely for taking care of their grandmother, mother, sister. She died, not connected to a web of tubes and IV lines, but rather, on the last of her own natural breath.